MEDICARE: MRS. KELLIE L PAXTON S.L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12061606	AR

General Provider Information

NPI Number	:	1811166226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLIE L PAXTON S.L.P.

Provider Business Mailing Address
First Line	:	5305 VILLAGE PKWY STE 1
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-387-4796
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 VILLAGE PKWY STE 1
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-387-4796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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Directions to “ MRS. KELLIE L PAXTON S.L.P.” Practice Location

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